Indian Journal of Community Medicine

Road Traffic Injury Prevention: A Public Health Challenge

Author(s): Jagnoor

Vol. 31, No. 3 (2006-07 - 2006-09)

After the first road fatality on 17th August 1896 in London,
the Coroner said, “This must never happen again”.1 More
than a century later, globally, 1.2 million people die each
year on roads.

Industrialization leads to economic growth, further leading
to increased mobilization of people, increased investment
on automobiles and road infrastructure. Therefore, effective
transportation supports a nation’s economic and social
growth. Most of the developing countries like India are at a
transition phase of growth and development2. India has one
of the largest highway and road network second only to road
network of U.S. Total road length exceeds 3 million3; and it
has about one percent of world’s vehicle population, but six
percent of the world’s road accidents occur in India4.

Air and noise pollution are some visible effects on the roads,
but a deeper underlying problem of injuries and death on the
roads goes unaccounted and neglected. Over 80,000 people
die in the traffic crashes annually, 1.2 million are seriously
injured and about 300000 disabled permanently5. In India,
among individuals more than 4 years of age, more life years
are lost due to traffic crashes than due to cardiovascular
diseases or neoplasms6.

Hospitals, medical centers and institutions, police records,
insurance data, special surveys/epidemiological studies and
vehicle operators are some of the sources for data, used
worldwide in regards to road traffic injuries and mortality7.
Many studies conducted in various parts of the country,
and records from concerned departments, show huge
discrepancies in the data5,8,9. A conservative estimate of
1:15:70 has been made for ratios between deaths, injuries
requiring hospital treatment, and minor injuries.

Pedestrians, bicyclists and motorized two wheelers have
been identified as the most vulnerable group constituting
60-80% of road fatalities in India. Two wheelers, motorized
(70%) and non-motorized (10-35%) vehicles are the main
component of Indian traffic. Less than 1 in 40 families own
a car5. It has also been observed that fatal crashes with
pedestrians, bicyclists and motorized two-wheelers involved
buses and trucks in higher proportion (50- 70%) than non fatal
crashes2. Occupants of two wheelers and occupants of public
and private transport is another group of people constituting
the majority, to be affected in road traffic injuries10. On
highways, occupants of cars are the most vulnerable group,
next to pedestrians5.

Various studies in different parts of the country found that
highest numbers of road crash victims were between the
ages of 20-40 years2,5,11. A study conducted in Pondicherry,
shows that males causalities (83%) were far more than
female causalities (17%) on roads. The same study also
found that victims with higher education (matriculation or
above) were fewer in proportion2. People from lower income
groups are further identified as high-risk category5.

A study in Bangalore showed that 44% of crash two wheelers
drivers, seeking medical treatment were under the influence
of alcoho15. Data at national level is not available, but drink
driving apparently is a big issue. A study conducted on
brain injuries also revealed that, there were higher rate of
falls and severity of brain injury was also more, amongst
drivers under the influence of alcohol13. There is a need for
stringent laws and their enforcement to restrain drink driving.
Public awareness regarding hazards of drinking and driving
should be increased through mass media and educational
campaigns.

Perhaps, drivers fault can also be attributed to system of
issuing license. License is issued to anyone who is above
18 years, can identify a few road signs. The licensing officer
would rarely stand by the road and watch you drive for 500
meter, leading to unskilled and ignorant drivers on roads.
Making learners license mandatory, with specific guidelines,
better system for testing driving skills, and curtailing under
age drivers through law enforcement are some of the steps
that might prove to be of help2,5. In most parts of the country,
but not all, male drivers are enforced to wear helmets2 and
a few years ago a law for passengers was also introduced,
but none of it is implied to females (drivers/passengers) or
child passengers.

Motorized and non-motorized vehicles and pedestrians
share same road space. An evidence of conflict between the
motorized and non motorized vehicles is evident from New
Delhi data according to which, 40% of fatal bicycle crashes
occur during peak hours when speed is low (20-30 km/hr)
but volumes are significantly high. This is not the situation
only on city roads, but on all roads, including highways, where heavy motorized vehicles and bullock carts share
the same space5.

Though there is no data available on accidents and fatalities
related to two wheeler vehicles and animal collision, but
local newspapers have news of such accidents on almost a
weekly basis. People and authorities seem to be aware of
the situation, but it appears that there is an ongoing blame
shifting from one department to another. Little has been done
to improve the situation. There is a need of co-coordinated
effort to attain a solution.

Indian Road Congress issues guidelines and standards
for all Indian roads and highways. These standards are
recommendatory and not mandatory. There is no authority
to view whether or not these recommendations are being
followed. Recognizing the issues due to mixed traffic and its
growth, there is a need to initiate evidence-based changes in
Indian road designing. Also there is need for some regulatory
changes in order to improvise a body, which is responsible
for implementation of road design standards5.

As mentioned above, mechanical faults contributed to 3%
of accidents, conditions of vehicle need to be checked on
regular basis. There is no law regarding smooth tyres, and
brake conditions etc. A system for regular check of vehicle
condition, might improve vehicle and road safety. An added
advantage would be air pollution check.

Though there is no law for rear passengers to wear seat belt,
but except for a few very expensive models, vehicles do not
even have the facility of rear passenger seat belts. Most
vehicles lack features like high mounted rear brake lights, air
bags, rear wipers etc5. Understanding the relevance of these
features, contribution from engineering and manufacturing
companies is required to bring about changes for improved
vehicle safety.

Pedestrians constitute one of the most vulnerable groups for
road traffic injuries. In minds of Indian road users there is
no place for pedestrians on roads4; one would observe that,
zebra crossings are made on very few roads in the country,
and those, which exist, are not used by the pedestrians
or the rules are not followed by the traffic. Also, subways
built in few cities are homes for beggars than pathways
for pedestrians. Though all vehicles share the same road
space, there are no laws or regulations for using roads or
safety guidelines for bicyclists, rickshaw pullers and other
non-motorized vehicles5.

No comprehensive data is available to how many children
die or are injured on their trip to school. Observing children
popping out of various kinds of vehicles at a school gate
and going through newspapers can fairly provide an idea of
how unsafe trips to schools are; a rickshaw with a passenger
capacity of no more than 3 would be loaded with 10 -14
children, bus with a capacity of 54 passenger would be
carrying 100-150 children, with bus driver as the sole care
taker. After series of deaths of school children in New Delhi,
admissions in schools were restricted by area of residence14.
Regular maintenance of school buses is presently an issue of
debate in the city. This is the only progress in the capital city
of the nation; issue in the nation is yet to be addressed.
It is very difficult to assess the economic cost of road
crashes. In Indian society death or disability of one family
member would affect education and career opportunities for
all the family members. Scarcity of rehabilitation facilities,
lack of welfare functions and aids further deteriorates any
employment opportunity for the disabled and increases the
investment of time and money by the family members of
the victim15.

In a developing country like India, public health facilities
are scarce. Only 0.9% of GDP is spent on public medical
services16. Ambulance or a first aid team attends hardly any
accident victim. On the contrary public hires a transport
for the victims to hospitals, and many a time even that is
avoided due to legalities involved3,5. There is a need for an
affordable, effective and sustainable intervention for post
crash trauma care.

Preventing road crashes and the injuries is the most
important area that calls for attention of the policy makers,
as it is not only important for health, social and transportation
perspective, but is also cost effective. According to estimates
of 1995, 3.2% of GDP is the estimated cost of road traffic
injuries, in India5. In 1884, Louis Pasteur told his students
that “when meditating over a disease, I never think of finding
a remedy for it but, instead, a means of preventing it”17.
Perhaps, prevention of these road incidents is the best path,
but before radical steps can be taken, a lot of research is
required to be done.

In the wake of above discussed issues, it is important to
implement strategic interventions. No intervention can
be successful in the absence of effective and accurate
surveillance system, and hence is the primary need.
Unavailability of reliable data sources in India indicates that
foundation for road safety is yet to be laid in this country.
Interventions based on vague data cannot succeed. Hence
primarily intervention is required in data collection and
analysis.

This would involve a collaborative effort by all the sectors
involved. Police data collection needs to be more defined and
extensive. For the road safety professional database should
be able to provide information about location (coordinate
maps, km post etc), detailed timing, people involved and
injured in relation to vehicle age, sex; vehicles, animals and
road side objects. Resultant crash injuries and property
damage are also relevant. It’s also important to consider
environmental conditions like weather, road surface condition,
and light etc7. Hospitals and all other medical institutions need
to establish traffic injuries surveillance system in accordance with WHO guidelines. Further collaborated efforts by various
institutions of engineering, medicine, law etc are needed
to conduct research and train teams to collect coordinated
data7,18.

Also there is need for institutional changes, which would
involve aspects of road engineering, hospitalization,
academic changes-vocational training specific to each safety
issues. Safer roads and vehicles need to be developed
and maintained. At least, personnel’s involved in public
transportation must be given training in first aid skills5,11.
Public support is of utmost relevance, as it is primarily an
issue of changing attitudes. Special campaigns should be
organized, especially involving young drivers. Regulatory
changes and law enforcement are another critical aspect.

Even the existing laws fail to be enforced due to inadequate,
inefficient and corrupt system. Tragedies on road often
do not catch media attention; they are only, a part of local
newspaper. There is a need for all members of the society
to understand the relevance of road safety including media,
policy makers and all road users5.

Strategic changes in the existing system would help evolve
a better system for future. Sustained, collaborative and
concentrated efforts are required. Else, the once considered
blessing of technology which has become a necessity today
will become an abuse and may lead to unbearable human
loss in terms of burden of disability and death due to road
traffic crash.